<?php
/*
 * To change this template, choose Tools | Templates
 * and open the template in the editor.
 */
?>
<form id="marketplace_order_form" action="#" onsubmit="tb_remove();return false;">
    <div class="table">
        <div class="table_left">
            <label for="store_name">Full name</label>
        </div>
        <div class="table_right">
            <input type="text" name="val[store_name]" value="{value type='input' id='store_name'}"  size="80" maxlength="100" />
        </div>
    </div> 
    <div class="table">
        <div class="table_left">
            <label for="store_name">Product's code</label>
        </div>
        <div class="table_right">
            <input type="text" name="val[store_name]" value="{value type='input' id='store_name'}"  size="80" maxlength="100" />
        </div>
    </div> 
    <div class="table">
        <div class="table_left">
            <label for="store_name">Quantity</label>
        </div>
        <div class="table_right">
            <input type="text" name="val[store_name]" value="{value type='input' id='store_name'}"  size="80" maxlength="100" />
        </div>
    </div> 
    <div class="table">
        <div class="table_left">
            <label for="store_name">Delivery date</label>
        </div>
        <div class="table_right">
            <input type="text" name="val[store_name]" value="{value type='input' id='store_name'}"  size="80" maxlength="100" />
        </div>
    </div> 
    <div class="table">
        <div class="table_left">
            <label for="store_name">Delivery Address</label>
        </div>
        <div class="table_right">
            <input type="text" name="val[store_name]" value="{value type='input' id='store_name'}"  size="80" maxlength="100" />
        </div>
    </div> 
    <div class="table">
        <div class="table_left">
            <label for="store_name">Phone number</label>
        </div>
        <div class="table_right">
            <input type="text" name="val[store_name]" value="{value type='input' id='store_name'}"  size="80" maxlength="100" />
        </div>
    </div> 
    <div class="table">
        <div class="table_left">
            <label for="store_name">Payment</label>
        </div>
        <div class="table_right">
            <input type="text" name="val[store_name]" value="{value type='input' id='store_name'}"  size="80" maxlength="100" />
        </div>
    </div> 
    <div>
            <input type="submit" class="button button_submit" value="Submit"/>
            <input type="submit" value="Cancel" onclick="tb_remove();return false;" class="button_cancel" />
    </div>
</form>

